Association Between Admission Blood Pressure and In-hospital Mortality and Long-term Mortality of Patients With ST-elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A China Acute Myocardial Infarction Registry Study.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Reviews in cardiovascular medicine Pub Date : 2025-08-30 eCollection Date: 2025-08-01 DOI:10.31083/RCM33512
ZhiFeng Song, Chilie Danzeng, Yu Jiang, JinGang Yang, WeiXian Yang, HaiYan Qian, YueJin Yang
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引用次数: 0

Abstract

Background: Globally, acute myocardial infarction (AMI) is among the primary causes of mortality. The ideal approach for blood pressure (BP) management for patients experiencing ST-segment elevation myocardial infarction (STEMI) who receive percutaneous coronary intervention (PCI) remains a topic of ongoing debate. Current guidelines on BP management lack specific recommendations for STEMI patients undergoing PCI, resulting in substantial individual variability and uncertainties in clinical treatment strategies. This research seeks to determine the ideal BP levels linked to the lowest risk of in-hospital mortality and long-term adverse endpoints in STEMI patients receiving PCI.

Methods: This retrospective study analyzed data from the China Acute Myocardial Infarction (CAMI) Registry, enrolling 10,482 STEMI patients undergoing PCI at 108 Chinese hospitals from January 2013 to September 2014. The primary outcome was in-hospital mortality. Secondary outcomes included 2-year all-cause mortality, severe bleeding, and major adverse cardiac and cerebrovascular events (MACCEs), defined as a combination of all-cause mortality, myocardial infarction (MI), or stroke. The analysis of the relationship between admission systolic blood pressure (SBP)/diastolic blood pressure (DBP) and the primary and secondary outcomes as continuous and categorical variables was conducted using restricted cubic spline (RCS) analysis and Cox regression models.

Results: RCS analysis revealed that a J-shaped association existed between admission SBP/DBP and the risk of the primary outcome, with significant nonlinearity (both p < 0.001). Both lower and higher SBP/DBP levels were linked to an elevated risk of in-hospital mortality. The ideal SBP/DBP levels to minimize the in-hospital mortality risk were 157/94 mmHg. Compared to the reference SBP/DBP group (120-129/70-79 mmHg), lower admission SBP (<109 mmHg) or DBP (60-69 mmHg) significantly elevated the risk of the primary outcome. The adjusted hazard ratio (HR) for SBP levels of 100-109 mmHg and <100 mmHg was 1.08 (95% confidence interval (CI): 1.00-1.17; p = 0.0395 and p = 0.043, respectively), and for DBP of 60-69 mmHg, the adjusted HR was 1.07 (95% CI: 1.01-1.14, p = 0.0305). Similarly, the J-shaped curve was also noted between SBP/DBP and secondary outcomes, such as all-cause mortality, severe bleeding and MACCEs. However, no significant non-linear relationship was observed between SBP/DBP and recurrent MI at 2-year follow-up.

Conclusions: Among STEMI patients undergoing PCI, a J-curve relationship in in-hospital mortality was observed with a nadir at 157/94 mmHg. Similar J-shaped trends were also observed for secondary outcomes including all-cause mortality, severe bleeding and MACCEs. However, no significant nonlinear correlation was found between admission BP and recurrent MI within 2 years.

Clinical trial registration: NCT01874691, https://www.clinicaltrials.gov/study/NCT01874691?term=NCT01874691&rank=1.

经皮冠状动脉介入治疗st段抬高型心肌梗死患者入院血压与住院死亡率和长期死亡率的关系:一项中国急性心肌梗死登记研究
背景:在全球范围内,急性心肌梗死(AMI)是死亡的主要原因之一。st段抬高型心肌梗死(STEMI)患者接受经皮冠状动脉介入治疗(PCI)后血压(BP)管理的理想方法仍然是一个持续争论的话题。目前的BP管理指南缺乏针对STEMI患者行PCI的具体建议,导致临床治疗策略存在很大的个体差异和不确定性。本研究旨在确定与接受PCI的STEMI患者住院死亡率最低风险和长期不良终点相关的理想血压水平。方法:本回顾性研究分析了中国急性心肌梗死(CAMI)登记处的数据,纳入了2013年1月至2014年9月在中国108家医院接受PCI治疗的10482例STEMI患者。主要终点是住院死亡率。次要结局包括2年全因死亡率、严重出血和主要心脑血管不良事件(MACCEs), MACCEs定义为全因死亡率、心肌梗死(MI)或中风的组合。采用限制性三次样条(RCS)分析和Cox回归模型分析入院收缩压(SBP)/舒张压(DBP)与主要和次要结局作为连续变量和分类变量的关系。结果:RCS分析显示入院收缩压/舒张压与主要结局风险呈j型相关,且存在显著的非线性关系(p < 0.001)。较低和较高的收缩压/舒张压水平都与院内死亡风险升高有关。降低院内死亡风险的理想收缩压/舒张压水平为157/94 mmHg。与参考收缩压/舒张压组(120-129/70-79 mmHg)相比,入院收缩压较低组(p = 0.0395和p = 0.043)和舒张压为60-69 mmHg组,调整后危险度为1.07 (95% CI: 1.01-1.14, p = 0.0305)。同样,收缩压/舒张压与次要结局(如全因死亡率、严重出血和MACCEs)之间也存在j型曲线。然而,在2年随访中,收缩压/舒张压与复发性心肌梗死之间没有明显的非线性关系。结论:在接受PCI的STEMI患者中,院内死亡率呈j曲线关系,最低点为157/94 mmHg。次要结局也观察到类似的j型趋势,包括全因死亡率、严重出血和MACCEs。然而,入院时血压与2年内心肌梗死复发之间没有明显的非线性相关。临床试验注册:NCT01874691, https://www.clinicaltrials.gov/study/NCT01874691?term=NCT01874691&rank=1。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Reviews in cardiovascular medicine
Reviews in cardiovascular medicine 医学-心血管系统
CiteScore
2.70
自引率
3.70%
发文量
377
审稿时长
1 months
期刊介绍: RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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